CIVCO is focusing on three aspects of Multi-Modality Imaging this year: image fusion, CT guidance and ultrasound guidance.  CIVCO’s eTRAX™ and VirtuTRAX™ needle tracking systems increase clinical confidence and accuracy in targeting the type of difficult-to-access lesions frequently treated using image fusion. Our newest product, RAD-GUIDE, is a needle guidance solution for CT and Fluoroscopy. Finally, we showcase our wide variety of general purpose and endocavity needle guides for ultrasound and our infection prevention supplies, including transducer covers.

We’re especially excited about launching RAD-GUIDE.  RAD-GUIDE allows physicians a method for introducing needles under CT or Fluoroscopy by visualizing and adjusting planned punctures prior to needle entry. With RAD-GUIDE, clinicians no longer have to expose their fingers to radiation while checking needle location! Stop by the booth for a full demonstration, and see our feature article in Program Online for more details.

As always, thanks for reading! If you have a suggestion for Program Online, email me at Liz.Etchells@CIVCO.com

Liz Etchells

Editor, Program Online

CIVCO's RAD-GUIDE

CIVCO Medical Solutions, the leading provider of ultrasound needle guidance solutions, is committed to introducing new guidance solutions across the different imaging modalities. At RSNA 2011, CIVCO is introducing RAD-GUIDE™, a needle guidance solution for CT and Fluoroscopy. “As imaging modalities evolve, CIVCO is committed to translating our expertise in ultrasound needle guidance to other modalities,” said Robin Therme, VP of Multi-Modality Imaging for CIVCO. “RAD-GUIDE is the first of many such products to come.” RAD-GUIDE demonstrations are available at CIVCO’s RSNA booth, #8309.

RAD-GUIDE is a needle guide designed with simplicity and flexibility in mind. The device allows physicians a method for introducing needles under CT or Fluoroscopy by visualizing and adjusting planned punctures prior to needle entry.

“RAD-GUIDE was invented to facilitate needle insertion by holding the needle in the correct orientation, especially for difficult angulation and positioning,” said Dr. Luc Lacoursière, MD, FRCPC. “RAD-GUIDE helps reach difficult targets, including those that are small and deep inside the body. It also reduces procedure length and reduces x-ray exposure for both the patient and the radiologist.”

The guide allows proper needle support and orientation for everyday problems such as needle navigation while corresponding to a CT image. RAD-GUIDE is intended for use in procedures such as biopsy, drainage, injection and ablation.

RAD-GUIDE and CT Needles

The RAD-GUIDE design gives added needle support for superficial as well as deep puncture procedures, providing the flexibility to perform a wide variety of CT guided procedures. RAD-GUIDE consists of a teal needle guide base, Top-Plate and adhesive strip. Once in position, centered above the skin entry point, the adhesive strip allows the guide base to be securely positioned. The grid-like perforation pattern on the Top-Plate provides sturdy support for multiple instruments. RAD-GUIDE allows physicians to introduce needles with accurate orientation by aligning the appropriate path to the anatomic target.

“Needles, especially longer and heavier needles, do not hold proper orientation at the beginning of procedures, especially when the supporting tissues are thin, such as the chest wall,” said Lacoursière. “In order to avoid redirecting the needle many times before advancing it to the target, a device should hold the needle at the right angle and orientation. This method avoids losing time, decreases x-ray exposure and avoids incorrect needle insertion.”

Preliminary clinical use demonstrates improved accuracy and reduced needle re-positioning with use of a needle guide. RAD-GUIDE enables greater efficiency and a reduction in procedure time for clinicians, resulting in a higher throughput of patients. Further, RAD-GUIDE offers an opportunity to improve patient care while minimizing hospital risk. RAD-GUIDE facilitates improved visualization of the needle trajectory and a reduction in the number of needle re-positions and punctures during a procedure. Through these benefits, hospitals are able to minimize the risks associated with accidental puncture.

RAD-GUIDE in use.

Additionally, RAD-GUIDE allows physicians to reduce high dose radiation exposure with a “hands-free” approach to punctures. “The RAD-GUIDE addresses concerns about precision, safety, rapidity and radiation exposure,” said Lacoursière. “It is very simple to use, and you do not have to expose your fingers to x-rays anymore!” Improved success rates and reduced radiation exposure both help raise clinical confidence in needle punctures and improving patient and staff safety.

For more information on RAD-GUIDE, contact your CIVCO account rep or visit www.CIVCO.com.

CIVCO’s MMI products include a wide range of infection control products, including ultrasound and CT covers, as well as ultrasound and CT device guidance, positioning, electromagnetic tracking and needle tracking for image fusion. At RSNA 2011, CIVCO is focusing on needle and instrument guidance for image fusion, CT and ultrasound.

Image Fusion: CIVCO’s Needle Guidance Solutions

eTRAX During Procedure

CIVCO recognizes that at any given time, a hospital imaging department has numerous imaging modalities in use. Traditional ultrasound imaging has multiple advantages: images are viewed in real-time, no radiation is delivered and ultrasound is comparatively inexpensive. However, modalities like CT and MRI deliver much more highly detailed images. By fusing the real-time ultrasound image with the more detailed, static CT or MRI image, interventional radiologists can gain the best of both devices.

CIVCO’s eTRAX™ and VirtuTRAX™ needle tracking systems increase clinical confidence and accuracy in targeting the type of difficult-to-access lesions frequently treated using image fusion. Both facilitate electromagnetic needle tip tracking in real-time and in conjunction with pre-acquired 3D volume datasets like those from CT or MRI scans.  When using either system, the location and orientation of the needle is clearly displayed on-screen, reducing procedure time, improving workflow and increasing patient safety. eTRAX and VirtuTRAX are frequently used for biopsy, drainage and ablation procedures.

CT Guidance: RAD-GUIDE™ by CIVCO

CIVCO's RAD-GUIDE

CIVCO’s newest introduction is RAD-GUIDE, a CT needle guide designed with simplicity and flexibility in mind. RAD-GUIDE allows proper needle support and orientation for everyday problems such as needle navigation while corresponding to a CT image. The device facilitates the introduction of needles under CT or Fluoroscopy by visualizing and adjusting planned punctures prior to needle entry.

“RAD-GUIDE was invented to facilitate needle insertion by holding the needle in the correct orientation, especially for difficult angulation and positioning,” said Dr. Luc Lacoursière, MD, FRCPC, President of Datum Medical and inventor of RAD-GUIDE. “RAD-GUIDE helps reach difficult targets, including those that are small and deep inside the body. It also reduces procedure length and reduces x-ray exposure for both the patient and the radiologist.”

RAD-GUIDE is intended for use in procedures such as biopsy, drainage, injection and ablation. For a full video demonstration of RAD-GUIDE, click here.

Ultrasound Guidance: CIVCO Needle Guidance and Infection Prevention

CIVCO's Infiniti needle guidance system

CIVCO is the industry leader in ultrasound needle guidance and infection prevention. We design, manufacture and market general purpose, endocavity and specialty needle guidance solutions for all major OEMs. Our needle guides are available in both disposable and reusable configurations, and all endocavity guides correspond to on-screen software guidelines. CIVCO’s ultrasound covers & equipment drapes protect against the risks associated with cross-contamination and are available in a wide range of materials and sizes. When used together, CIVCO’s ultrasound products provide for patient and staff safety during ultrasound and interventional procedures.

Visit our RSNA booth #8309 to see the full range of CIVCO needle guidance for image fusion, CT and ultrasound as well as our line of infection prevention solutions.

Luc Lacoursière, MD, FRCPC

Dr. Luc Lacoursière, MD, FRCPC is president of Datum Medical. Dr. Lacoursière is also a practicing interventional radiologist and Chief of Interventional Radiology at Hôtel-Dieu in Quebec and a clinical professor at Laval University, (Quebec City).

When and how did you become interested in the field of interventional radiology?
During my first training course in interventional radiology, I immediately knew I wanted to be an interventional radiologist. I did not only want to diagnose health problems, but also wanted to work solving them. I needed to work with my hands, not only with my brain! I wanted to use imaging as a tool to treat patients, and to go beyond the images and use the extraordinary technology that was available.

What do you consider the most rewarding aspects of your career?

Helping people (patients) with their disease and sickness, being efficient and mainly, minimally invasive. The RAD-GUIDE is a way for me to help the other physicians achieving this goal.

What have been the most important technological advances in the past 10 years?

As an “interventional oncologist”, many technologies have changed the way we treat patients, including ablation techniques (radio-frequency, cryotherapy, microwaves). That’s why we need devices to help us precisely place our needles in tumors. Theses technologies really change lives. Also, delivering medication directly within tumors such as with intra-arterial microspheres and beads injections has a great potential.

What technological changes do you expect in your field over the next decade?

I think the previously mentioned innovations will continue to evolve. Nanotechnologies with injection of selected medications and antibodies will probably play an important role in which interventional radiology will be involved.

Joy Guthrie

Joy Guthrie is the current president of the Society of Diagnostic Medical Sonographers and program director of the sonography program and Ultrasound Supervisor at Community Regional Medical Center in Fresno, California. Joy is a highly credentialed sonographer and has been active in multiple aspects of her profession throughout her career. She practices clinically, teaches, has held numerous offices in professional organizations and is an advocate of the national CARE bill.

What type of sonography do you specialize in?
I perform all modalities, but my specialty is echocardiography—-with a focus on fetal and pediatric populations.

How did you become interested in the field of sonography?
I was introduced to sonography in 1984.  The first time I saw an echocardiogram, I was hooked. It is a great combination of art and science and continually changing with technological advances.

What are the most significant technological advances you’ve seen over the course of your career?
Digitization of images – DICOM. 

What technology do you anticipate being development over the next decade?
The expansion of the utilization of 3D and 4D technology.

Comment on your participation and leadership role within SDMS – how has this helped your personal and professional development, and how do you see the role of the society within the field of sonography?
My decision to get involved with the SDMS was based on my experience of what can happen when patients are subjected to sonography services provided by untrained or uneducated operators.  Unfortunately, most patients are not knowledgeable enough to ask the appropriate questions, and those questions relate directly to the issue of appropriate education and training of the person who is performing their sonography examination.  The minimal level standard for competency demonstration in sonography is having successfully completed one of the national sonography credentialing exams.  The fact that the credentialing/certification standard is not required is an oversight in our healthcare system/management that needs to be attended to.  That was what spurred my interest in getting involved with the professional association community in sonography.  The ‘voice’ for this quality control standard on behalf of patients is the CARE bill currently pending in Congress.  As an organization, we are deeply committed to getting this bill, based on certification standards for non-physician providers of medical imaging, including sonographers, passed.  While that was my initial motivation in affiliating with the SDMS I found opportunities that also furthered my professional development.  I have had opportunities to work with some incredibly talented people within SDMS—I have experienced significant leadership growth and have learned first hand the benefit of knowledge-based governance.  When sonographers, through their professional association, speak with a unified voice what may have been impossible to achieve as a single individual becomes possible.  My role in this process is to continue to facilitate the discussion and keep our collective ‘eye’ focused on the ‘prize’—that prize right now is the establishment of quality standards for patient care.  I consider it a privilege to have been provided with this opportunity.

You have several degrees that relate to your profession. Why did you feel it was important to continue with your education, and how do these credentials assist you in your career?
I felt that it was my obligation to be credentialed in all specialty areas that I practice. I also felt a doctorate degree was appropriate in order to teach at a college level. This was my commitment to meet the standard in both my clinical and educational roles.

What advice do you have for new sonographers?
Understand that the day you enter the profession is the first day of what will be and should be a lifelong commitment to education and skill refinement.  As you start down that pathway understand that there are others who have already been ‘on the road’ for some time.  These ‘others’ are your professional colleagues in whose company you will find professional growth and development.  You should seek these opportunities out; you will find them in your professional association…people who understand that sonography is a professional career choice and deserves your best efforts.  You will find the experience to be a rewarding one.

What has been your most rewarding experience within sonography?
Working with premature infants and giving back to my profession through teaching.

CIVCO’s eTRAX offers the next advancement in image guidance by tracking the tip of a needle using electromagnetic technology and real-time navigation in the interventional suite. This system allows physicians safe and precise placement of instruments during each procedure by monitoring the real-time trajectory of the needle as it advances.

The guide attaches by snapping into the locating features on the transducer, ensuring proper one-step positioning throughout the procedure. The quick-release mechanism allows users to place a catheter or device by removing the “hatch” without the hassle of removing the probe, thus eliminating the use of guide wires. The quick-release device offers three sizes in a single convenient procedure kit and is delivered fully assembled and ready for use, accepting instruments from 10-11GA, 14GA and 16-18GA. A minimum 19cm needle is recommended to reach the target area.

The disposable needle guide snaps into locator slots on the transducer, allowing proper positioning of the guide. The guide consists of a single-piece system, allowing ease-of-use and removal from the probe while providing quick clean-up between procedures. It is intended for single-use, is compatible with instruments 16cm or longer and accepts 16-18 gauge instruments. Anticipated applications include endovaginal gynecology and obstetrics.

Anticipated clinical applications include abdominal & pediatric body surface scanning and fetal scanning. Sterile procedure kits contain the BX2 needle guide, transducer cover, gel packet and colored elastic bands.